Search

Objective: To examine severity of dysphagia and outcomes following iatrogenic high vagal nerve injury. Methods: Retrospective chart review of all patients with iatrogenic high vagal nerve injury that were seen at a tertiary referral center from 2012 to 2020. Results: Of 1304 patients who met criteria for initial screening, 18 met all inclusion criteria. All 18 required intervention to address postoperative dysphagia. Eleven required enteral feeding tubes with 7 eventually able to advance to exclusively per oral diets. Fourteen underwent vocal fold injection and 6 underwent laryngeal framework surgery. Sixteen pursued swallowing therapy with speech language pathology. Patients lost a mean of 8.6 kg of weight in the 6 months following the injury. Swallowing function on the Functional Outcome Swallowing Scale (FOSS) and Functional Oral Intake Scale (FOIS) was 4.4 and 2.4 respectively immediately following the injury and improved to 1.9 and 5.3 at the last follow-up. No patients had complete return of normal swallowing function at last follow up. Conclusion: Iatrogenic high vagal injury causes significant lasting dysphagia which improves with intervention but does not completely resolve. Interventions such as vocal fold injection, medialization laryngoplasty, cricopharyngeal myotomy, or swallowing therapy may be required to reestablish safe swallowing in these patients.

Thyroid cancer incidence, recurrence, and death rates are higher among Filipino Americans than European Americans. We propose that vitamin D binding protein (DBP) with multifunctionality with ethnic variability plays a key role within different ethnicities. In this study, we determined the correlation between differential DBP expression in tumor tissues and cancer staging in Filipino Americans versus European Americans. We assayed DBP expression by immunohistochemistry and analyzed the data with confocal microscopy on 200 thyroid cancer archival tissue samples obtained from both ethnicities. DBP-stable knockdown/gain-in-function assays were done by using DBP-shRNA/DBP-cDNA-expression in vitro. The majority of Filipino Americans presented with advanced tumor staging. In contrast, European Americans showed early staging and very few advanced tumors. A significantly low to no DBP staining was detected and correlated to the advanced staging in Filipino Americans. On the contrary, in the tumor tissues derived from European Americans, moderate to strong DBP staining was detected and correlated to early staging. When downregulation of the DBP gene in papillary thyroid cancer (PTC) cell lines was observed, tumor proliferation and migration were enhanced. On the other hand, the upregulation of the DBP gene decreased cell proliferation and migration in PTC cells. In conclusion, we determined a differential expression of an essential biological molecule (DBP) is linked to cancer staging in thyroid cancer health disparities in two ethnicities. Loss-of-DBP/gain-in-DBP-function influenced tumor progression. A future study is underway to determine the DBP regulation and its downstream pathways to elucidate strategies to eliminate the observed thyroid cancer health disparities.

Background While use of total thyroidectomy has increased in management of hyperthyroidism, concerns exist about increased surgical complication rates; most notably, hematoma, recurrent laryngeal nerve (RLN) injury, and hypocalcemia. Methods Retrospective cohort study of 454 patients undergoing total thyroidectomy between 2003 and 2015. All patients had surgery for hyperthyroidism, benign euthyroid disease, or thyroid malignancy. Results Total thyroidectomy for hyperthyroidism was not associated with an increased risk for any postoperative complication. Transient hypocalcemia, temporary dysphonia, and postoperative hematoma rates were not significantly different for patients with hyperthyroid (n = 91), euthyroid benign (n = 237), and malignant (n = 126) disease. Permanent hypocalcemia and recurrent laryngeal nerve injury were not noted in any hyperthyroid patients. Complication rates were similar for hyperthyroid patients with Graves' disease vs toxic multinodular goiter. Conclusion This study affirms safety and efficacy of total thyroidectomy as standard treatment for hyperthyroidism.

Studies have shown that Asian Americans are more likely to be diagnosed with advanced-stage thyroid cancer than other ethnic groups. Among Asian Americans, Filipino Americans (FA) have the highest thyroid cancer mortality rate compared to different subgroups. FA are known to be three times more likely to die of thyroid cancer than European Americans (EA). African American (AA) and Hispanic American (HA) patients have the worst cancer-specific survival rate compared to EA patients. Epidemiological studies in California have shown that thyroid cancer is the second most common cancer among Filipino American women (1). Although socioeconomic factors play a crucial role in cancer health disparities, thyroid cancer is an exception, where educated FA showed higher incidence/recurrence rates (2). Currently, no studies demonstrate the biological mechanism behind these discrepancies. We are the first to show differential expressions of a tumor suppressor gene (1) and miRNA profiles between FA versus EA (2). We have discovered a new oncogene, PDLIM7, also known as Enigma, with a stage-dependent enhancement in thyroid cancer tissues (3). Our Hiseq-miRNA profiling data showed significant downregulations of one of the well-known tumor suppressor miRNAs, Let-7 family genes. Some of the let-7 family genes are significantly downregulated in FA versus EA (2). Let-7 genes are known to regulate PDLIM family genes. Therefore, we hypothesize that the inverse correlation between PDLIM7 oncogene and Let-7 family genes is linked to advanced thyroid cancer in FA compared to all other ethnicities. In this study, we have expanded our patient cohorts by adding samples from AA and HA to our existing patient cohorts of EA and FA. We determined the differential PDLIM7 gene expression in different ethnic groups using the Cancer Genome Atlas (TCGA) thyroid cancer datasets by UALCAN assay. We also confirmed the PDLIM7 gene and let-7 family expressions by RT-qPCR in different ethnic groups and correlated them to thyroid cancer staging. We found a significantly overexpressed PDLIM7 gene in FA with advanced-stage compared to EA/HA/AA. Among others, PDLIM7 did not show any significant difference. A higher expression of the PDLIM7 gene (*p Citation Format: Jaibir S. Pannu, Kristiana Rood, Celina R. Yamauchi, Alfred A. Simental, Mia C. Perez, Anthony Firek, Salma Khan. Inverse correlations between PDLIM7 and let-7 family gene expressions in advanced thyroid cancer tissues from specific racial/ethnic groups [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr C061.

Tumor recurrence following treatment remains a major clinical challenge in oral cavity cancer. Cancer stem cells (CSCs) have been isolated from human oral cancers and been considered as the driving force of tumor recurrence and metastasis. However, it still remains unclear whether targeting CSCs in oral cancer is a clinically relevant strategy to combat cancer recurrence and metastasis. Here, using clinical cancer specimens and patient-derived xenografts, we show that the self-renewal regulator BMI1 is highly expressed in CSCs of oral cavity squamous cell carcinoma. Inhibition of BMI1 decreases oral CSCs' self-renewal and tumor-initiating potential. Treatment of pre-established human oral cancer xenografts with a BMI1 inhibitor resulted in abrogation of tumor progression and reduced the frequency of CSCs in the xenografts. Remarkably, the BMI1 inhibitor has therapeutic effects in cisplatin-resistant tumors and can reduce metastases initiated by circulating CSCs. Mechanistically, BMI1-inhibition leads to oral CSC necroptotic cell death, which underlies the self-renewal impairment after inhibiting BMI1. Our data provide a pre-clinical proof-of-concept that targeting BMI1-related CSC self-renewal is a clinically relevant anti-cancer therapy in human oral cavity squamous cell carcinoma.

To determine the prevalence of separate and combined voice and swallowing impairments before and after total thyroidectomy and to delineate risk factors for these symptoms.Retrospective review of 592 consecutive patients who underwent total thyroidectomy from July 2003 to August 2015.Combined voice and swallowing problems occurred preoperatively in 4.7% (11/234), 3.3% (3/92), and 6.0% (16/266) of patients with malignancy, hyperthyroidism, and benign euthyroid disease, respectively. Postoperatively, prevalence was 5.1%, 2.2%, and 1.9%, respectively. Benign euthyroid disease (20.7%) had the greatest risk of preoperative dysphagia (P = 0.003) and the largest glands (P0.001). Comparing before and after surgery, the cancer and benign euthyroid groups had decreased dysphagia (cancer: 11.5% vs. 6.0%, P = 0.034; benign: 20.7% vs. 3.8%, P0.001) but increased dysphonia (cancer: 19.2% vs. 28.6%, P = 0.017; benign: 15.8% vs. 27.1%, P = 0.002). Overall, 23/592 (3.9%) developed new dysphagia and 122/592 (20.6%) developed new dysphonia after surgery. Intraoperative recurrent laryngeal nerve transection occurred in 12 cases (2.0%).Total thyroidectomy resolved dysphagia but increased dysphonia in benign and malignant euthyroid patients. Voice and swallowing problems following thyroidectomy occurred more frequently than intraoperative recurrent laryngeal nerve transection, confirming symptoms often occur in the absence of suspected nerve injury.

Thyroid carcinoma consists a group of phenotypically heterogeneous cancers. Recent advances in biological technologies have been advancing the delineation of genetic, epigenetic, and non-genetic factors that contribute to the heterogeneities of these cancers. In this review article, we discuss new findings that are greatly improving the understanding of thyroid cancer biology and facilitating the identification of novel targets for therapeutic intervention. We review the phenotypic features of different subtypes of thyroid cancers and their underlying biology. We discuss recent discoveries in thyroid cancer heterogeneities and the critical mechanisms contributing to the heterogeneity with emphases on genetic and epigenetic factors, cancer stemness traits, and tumor microenvironments. We also discuss the potential relevance of the intratumor heterogeneity in understanding therapeutic resistance and how new findings in tumor biology can facilitate designing novel targeting therapies for thyroid cancer.

OBJECTIVE To assess the accessibility and breadth of online information regarding neurotology fellowship programs by appraising individual fellowship websites as well as two popular online databases. METHODS The American Neurotology Society Program Information Page (ANSPIP), the American Medical Association's Fellowship and Residency Electronic Interactive Database (FREIDA), and three online search engines (Google, Yahoo, Bing) were assessed for accessibility to individual fellowship websites. Each program's ANSPIP data sheet and fellowship-specific website were then evaluated for the presence of 18 characteristics of interest to the neurotology fellowship applicant. RESULTS All three search engines yielded 23 (96%) Accreditation Council for Graduate Medical Education (ACGME)-accredited neurotology fellowship websites. Searching "Neurotology fellowships" in Google, Yahoo, and Bing required exploring up to nine pages of search results to identify all of the ACGME-accredited program-specific websites. Direct links to program websites were found on 12 (55%) and 3 (13%) of the ANSPIP and FREIDA fellowship pages, respectively. Of the 18 characteristics of interest, the ANSPIP data sheet and individual program websites on average delineated 8.0 and 7.8 characteristics, respectively. Ninety-one percent of fellowship websites included program coordinator information, general program description, and breadth of surgical exposure. In contrast, work/life balance, postfellowship placement, and current fellow(s) were least commonly displayed (4%, 9%, 13% respectively). One-hundred percent of ANSPIP data sheets included program coordinator information, number of fellows, and affiliated hospital(s), whereas none of the pages included selection criteria, application requirements, description of location, or work/life balance. CONCLUSION Although most neurotology fellowship programs have websites or ANSPIP data sheets, many of them lack information that has been previously demonstrated to be valued by applicants. Furthermore, incongruence of information between these sources may lead to confusion, applicant stress, and reflect poorly on fellowship programs. Perhaps a standardized list of ACGME-required data points to be posted on websites would facilitate the application process.

Thyroid cancer incidence is rising worldwide. Although fine-needle aspiration biopsy (FNAB) is an accurate modality for evaluating thyroid nodules, up to 25% of FNABs still yield indeterminate results. There is a considerable number of diagnostic thyroidectomies for benign disease as a result of indeterminate FNAB. A more accurate and time-efficient diagnostic approach for analyzing indeterminate thyroid nodules may reduce diagnostic thyroidectomy. Recently, the osteogenic protein, Enigma, has been associated with different cancer types, including thyroid cancer progression and calcification through its interaction with bone morphogenic protein-1 (BMP-1), and tyrosine kinases linked to mitogenic signaling pathways [1, 2]. Our published data on Enigma protein analysis with immunohistochemistry showed promising results in discriminating between malignant versus benign thyroid nodules and demonstrated a correlation with thyroid cancer staging [3]. In this study, we are investigating Enigma at a gene expression level by real-time (RT-qPCR), which is a quantitative and more time-efficient method that requires smaller samples (FNA) than immunohistochemistry. We analyzed Enigma mRNA expression levels to determine if Enigma-qPCR could be used as a diagnostic tool to improve the accuracy of FNAB in both malignant and benign thyroid tissues. We extracted mRNA/DNA/proteins from fresh malignant and benign thyroid nodules using a QIAGEN DNA/RNA/Protein Kit. We ran isolated pure mRNA through Enigma-qPCR. The results showed that the Enigma-mRNA expression was 3-fold higher in malignant as compared to benign thyroid tissues. This finding supports our previous Enigma immunohistochemistry data and shows a relative quantitative difference in Enigma-mRNA expression level between malignant and benign thyroid nodules. We conclude that Enigma-RT-qPCR can be used to effectively determine malignancies in FNAB samples derived from thyroid nodules. This method could potentially enhance the diagnostic accuracy of indeterminate nodules and decrease diagnostic thyroidectomies and associated morbidity. [1] C.R. Jung, J.H. Lim, Y. Choi, D.G. Kim, K.J. Kang, S.M. Noh, D.S. Im, Enigma negatively regulates p53 through MDM2 and promotes tumor cell survival in mice, The Journal of clinical investigation 120(12) (2010) 4493-506. [2] Y.J. Kim, H.J. Hwang, J.G. Kang, C.S. Kim, S.H. Ihm, M.G. Choi, S.J. Lee, Enigma Plays Roles in Survival of Thyroid Carcinoma Cells through PI3K/AKT Signaling and Survivin, Anticancer research 38(6) (2018) 3515-3525. [3] A.A. Firek, M.C. Perez, A. Gonda, L. Lei, I. Munir, A.A. Simental, F.E. Carr, B.J. Becerra, M. De Leon, S. Khan, Pathologic significance of a novel oncoprotein in thyroid cancer progression, Head & neck 39(12) (2017) 2459-2469.

Purpose To determine whether time interval between hemi-thyroidectomy and subsequent completion thyroidectomy impacts outcomes. Methods Retrospective review of 68 patients having completion thyroidectomy from August 2012 to December 2019. Patients were separated into two groups based on the time interval between surgeries: early (≤10 days) or delayed (≥90 days). Results Patients who underwent delayed completion thyroidectomy (n = 17) had significantly higher rates of hypocalcemia and/or hypoparathyroidism ( P = .03) and higher rates of requiring postoperative hospitalization ( P=.07) compared to those who underwent early completion thyroidectomy (n = 51). Delayed completion had significantly lower risk of developing one or more of dysphonia, dysphagia, or vocal cord paresis postoperatively ( P=.02). No patients developed hematoma or wound infection. Conclusions Delayed completion thyroidectomy is associated with increased rates of hypocalcemia, but lower rates of dysphonia and dysphagia. Given the low risk of long-term complications in both groups, it may be beneficial to perform completion thyroidectomy early in order to expedite cancer treatment.

Standard operative techniques for thyroidectomy have become well refined and widely disseminated. However, special circumstances, such as superior pole thyroid cancers, can present unique difficulties for the unprepared surgeon. Appropriate workup and appreciation of the unique anatomical relationships in the superior-most extent of the thyroid gland is vital in surgical planning. The ability to anticipate and manage a variety of contingencies such as superior laryngeal nerve sacrifice, vascular isolation and repair, laryngectomy, and repair of pharyngeal defects are essential for safe surgery for cancers of the extreme superior thyroid pole.

Background Thyroid disease occurs more frequently in patients with hyperparathyroidism than the general population and hinders parathyroid localization. Identifying thyroid pathology before operating improves management and avoids the risks of reoperation in the neck. This review assesses imaging studies in patients with hyperparathyroidism and thyroid pathology to identify the ideal imaging methodology for patients with multigland disease. Methods Systematic review of original articles reporting sensitivity or positive predictive value (PPV) for one or more imaging modalities in patients with hyperparathyroidism and thyroid disease. Results Twenty-eight studies, 13 prospective and 15 retrospective, met inclusion criteria. Nine modalities were evaluated, including: cervical ultrasound (n = 18), dual-phase 99m Tc-sestamibi (n = 14), subtraction scintigraphy (n = 11), combined ultrasound and scintigraphy (n = 8), single photon emission CT (SPECT; n = 5), SPECT-CT (n = 4), contrast-enhanced ultrasound (n = 1), CT (n = 1), and MRI (n = 1). Conclusion Combined ultrasound and scintigraphy is the most sensitive study to localize parathyroid adenomas in patients with hyperparathyroidism and thyroid disease, followed by hybrid SPECT-CT and SPECT.

Solitary fibrous tumor (SFT)/hemangiopericytoma (HPC) is a rare, slow growing vascular tumor. In the head and neck region, it is usually seen in the nasal or oral cavity, orbit, jaw, and parotid region. It has equal male to female distribution and affects mainly younger adults with median age of 45 years. According the World Health Organization, sometimes it is impossible to distinguish HPC from SFT and consequently, they are now classified as the same entity. The first line of treatment for this tumor is complete surgical removal with wide margins. In the head and neck area, wide margins can be very challenging and incomplete resection is associated with high rate of recurrence and malignant transformation. Embolization is a considerable option prior to excision, which helps reducing the tumor size and the risk of intraoperative hemorrhage. We describe a case of posterior neck solitary fibrous tumor/hemangiopericytoma that was completely resected following particle embolization of the feeding artery.

Background The incidence of thyroid cancer is increasing worldwide, and there is an emerging need to develop accurate tools for diagnosis. Fine needle aspiration biopsy has greatly improved evaluation of thyroid nodules, but challenges with indeterminate lesions remain in up to 25% of biopsies. Novel tissue biomarkers may assist in improved nodule characterization. Microcalcifications occurring in thyroid cancers suggest proteins involved in bone formation may play a role in thyroid carcinogenesis. We evaluated the expression of the known osteogenic protein, Enigma, in thyroid cancer as a candidate oncoprotein and role in carcinogenesis based on association with other known oncoproteins such as bone morphogenetic protein-1 (BMP-1). Methods The expression of both Enigma and BMP-1 were evaluated by immunohistochemistry (IHC) in an equal number of benign (n = 120) and different histological subtypes of malignant (n = 120) human archival thyroid nodules with and without calcification. The colocalization of Enigma with BMP-1 was evaluated by confocal microscopy using the BZ analyzer. Results Enigma was strongly expressed in thyroid cancer tissue with a higher immunoreactive score in advanced thyroid cancer compared to less advanced and benign nodules. Enigma was localized either in cytoplasm or nucleus depending on the histological subtypes. Higher expression of Enigma was associated with the tumor size and lymph node involvement. There was clear and strong colocalization signal of Enigma and that of BMP-1. Expression of Enigma occurred without regard to calcification in cancer tissue. Conclusion Enigma may serve as an oncoprotein marker, identifying benign from malignant thyroid tissue on FNA. Enigma may have a role in carcinogenesis of thyroid cancer independent of tissue calcification, possibly in relation to interaction with BMP-1.

Outpatient thyroidectomy has become slowly accepted with various published reports predominantly examining partial or subtotal thyroidectomy. Concerns regarding the safety of outpatient total and completion thyroidectomy remain, especially with regard to vocal fold paralysis, hypocalcemia, and catastrophic hematoma. We aimed to evaluate the safety of outpatient thyroid surgery in a large cohort by retrospectively comparing outcomes in those who underwent outpatient (n = 251) versus inpatient (n = 291) completion or total thyroidectomy between February 2009 and February 2015. Outpatient completion and total thyroidectomy had lower rates of temporary hypocalcemia (6% vs 24.4%; P < 0.001) and no significant difference in rates of return to emergency department (1.2% vs 1.4%), hematoma formation (0.8% vs 0.7%), temporary (2% vs 4.1%) or permanent (0.4% vs 0.7%) vocal fold paralysis, or permanent hypocalcemia (0.4% vs 0%) compared with the inpatient group. Outpatients requiring calcium replacement had shorter duration of postoperative calcium supplementation (44.4 ± 59.3 days vs 63.3 ± 94.4 days; P < 0.001). Our data demonstrate similar safety in outpatient and inpatient total and completion thyroidectomy.

Schwann cells (SCs) are hitherto regarded as the most promising candidates for viable cell-based therapy to peripheral nervous system (PNS) injuries or degenerative diseases. However, the extreme drawbacks of transplanting autologous SCs for clinical applications still represent a significant bottleneck in neural regenerative medicine, mainly owing to the need of sacrificing a functional nerve to generate autologous SCs and the nature of slow expansion of the SCs. Thus, it is of great importance to establish an alternative cell system for the generation of sufficient SCs. Here, we demonstrated that adipose-derived stem cells (ADSCs) of rat robustly give rise to morphological, phenotypic and functional SCs using an optimized protocol. After undergoing a 3-week in vitro differentiation, almost all of treated ADSCs exhibited spindle shaped morphology similar to genuine SCs and expressed SC markers GFAP and S100. Most importantly, apart from acquisition of SC antigenic and biochemical features, the ADSC-derived SCs were functionally identical to native SCs as they possess a potential ability to form myelin, and secret nerve growth factor (NGF), brain-derived neurotrophic factor (BDNF) and glia-derived neurotrophic factor (GDNF). The current study may provide an ideal strategy for harvesting sufficient SCs for cell-based treatment of various peripheral nerve injuries or disorders.

Objective To determine whether advanced imaging is cost-effective compared to primary bilateral neck exploration in the management of non-localizing primary hyperparathyroidism. Study design Cost-effectiveness analysis. Methods Cost-effectiveness analysis based on decision tree model and available Medicare financial data using data from 347 consecutive patients having parathyroidectomy for primary hyperparathyroidism with either 1) positive, concordant ultrasound and sestamibi or 2) negative sestamibi and negative ultrasound. Results Bilateral neck exploration (BNE) costs $9578 and has a success rate of 97.3%. Single photon emission computed tomography (SPECT) + minimally invasive parathyroidectomy (MIP) was modeled to have a total cost of $8197 with a success rate of 98.6%. SPECT/computed tomography (CT) + MIP was modeled to have a total cost of $8271 and a 98.9% success rate. Four-dimensional (4D)-CT + MIP was modeled to cost $8146 with a success rate of 99%. Incremental cost-effectiveness ratios (IECR) (as compared to BNE) were -536.1, -605.5, and -701.6 ($/percent cure rate) for SPECT, SPECT/CT, and 4D-CT respectively. One-way sensitivity analyses demonstrate the change in IECR and cut-off points (IECR = 0) for four major variables. Conclusions In patients with non-localizing primary hyperparathyroidism, advanced imaging is associated with cost-savings compared to routine bilateral neck exploration. Increased cost-savings were predicted with increased imaging accuracy and decreased imaging costs. Increasing time for BNE or decreasing time for MIP were associated with increased cost savings. Level of evidence III Laryngoscope, 2020.

To compare the efficacy of pain control and opioid consumption between patients who receive opioid as primary analgesic therapy and those who receive ibuprofen.Prospective randomized trial.Tertiary care academic hospital.Adult patients undergoing outpatient otolaryngology surgery were assigned to take hydrocodone/acetaminophen or ibuprofen for postoperative analgesia. Patient-recorded pain scores and analgesic consumption were analyzed.Out of 185 recruits, 108 (58%) completed responses. Fifty-six patients (52%) received opioid medication for primary analgesic treatment versus 52 (48%) who received ibuprofen. There was no difference in reported pain scores between the treatment groups. Those who received ibuprofen as primary therapy reported a significantly lower consumption of opioid medication at 2.04 tablets/pills (95% CI, 0.9-3.1) versus 4.86 (3.6-6.1; P = .001). Based on multivariate analysis, male sex and older age exhibited lower reported pain scores, while older age and use of ibuprofen as primary therapy exhibited lower opioid requirements.For postoperative pain management in outpatient otolaryngology procedures, ibuprofen as primary therapy can provide equally effective pain control as compared with hydrocodone/acetaminophen while decreasing overall opioid requirement. Prescription pill counts are further described to help guide physician practices in the era of an opioid epidemic.

Fine-needle aspiration (FNA) is one of the most accurate modes of obtaining thyroid nodule biopsies, however, up to 25% of biopsies still yield indeterminate results. There is an increasing number of thyroidectomies due to indeterminate nodules by FNA alone. Therefore, more accurate and time efficient diagnostic approaches for analyzing indeterminate thyroid nodules is required. Recent studies showed that Enigma is associated with different cancer types, including thyroid cancer progression and calcification through its interaction with bone morphogenic protein-1 (BMP-1) and tyrosine kinases linked to mitogen-activated protein kinase (MAPK) signaling pathway. Our published data on Enigma protein analysis with immunohistochemistry showed promising findings to discriminate malignant versus benign nodules. We also showed a thyroid cancer stage-dependent enhancement of Enigma protein expression. In this study, we are investigating Enigma at a gene expression level by quantitative reverse transcription polymerase chain reaction (RT-qPCR), which is more time-efficient, quantitative, and requires less tissue than immunohistochemistry. We extracted mRNA/DNA/proteins from fresh malignant and benign thyroid nodules using a Qiagen AllPrep DNA/RNA/Protein Mini Kit. After verification of the quantity and purity by NanoDrop, isolated mRNA was then run through Enigma-RT-qPCR. MAPK assay was done by western blotting using MAPK-antibody. Our initial results found that Enigma-mRNA expression level was 3-fold higher in malignant compared to benign thyroid tissues. This finding supports our previous protein expression data with a relative quantitative difference in Enigma-mRNA expression level between malignant and benign thyroid nodules. MAPK expression was upregulated in thyroid cancer compared to benign nodules. We conclude that Enigma-RT-qPCR can be used effectively in FNA samples derived from thyroid nodules, which could potentially enhance the diagnostic accuracy of indeterminate nodules and decrease unnecessary thyroidectomies. Furthermore, both Enigma and MAPK were highly expressed in advanced tumor in the same tissues. Future study is needed to establish the functional interaction of Enigma-MAPK activity in thyroid cancer cells.

Filipino Americans (FA) are known to have higher rates of thyroid cancer incidence and disease recurrence compared to European Americans (EA). FA are also known to be two times more likely to die of thyroid cancer compared to EA. Epidemiological studies in California have shown that thyroid cancer is the second most common cancer among FA women. Currently, there are no studies that demonstrate the mechanism behind these discrepancies. Evidence shows a strong correlation between obesity and more aggressive forms of thyroid cancer; obesity has an increased frequency in FA populations. The exact connection between the mechanisms of obesity and cancer is poorly understood. This epigenetic phenomenon may be due to microRNAs (miRNAs), which post-transcriptionally regulate gene expression. Dysregulated miRNA profiles have been associated with various diseases including obesity and cancer. MiRNAs are linked to different types of cancer; tumor suppressor genes and oncogenes are subject to modulation by dysregulated miRNAs. No study elucidates the association of miRNAs to tumor staging or prognosis in thyroid cancer health disparities. In this study, we determined miRNA expression profiles and found significant differences in the miRNA profiles between FA and EA thyroid cancer patients. Our pilot study showed several dysregulated miRNAs, from which we chose to assay dysregulated miR-4633-5p segments that are known to be associated with thyroid cancer signaling. We used QIAGEN’s miRNA extraction kit to obtain high-quality miRNA from paraffin-embedded thyroid tissues. We performed next-generation miRNA sequencing using equal number of FA and EA samples and identified the top ten significantly up- and down-regulated miRNAs from the pool of differentially expressed miRNAs by qPCR assays. Our investigation demonstrated a 1.5-2-fold higher expression of an upregulated miR-4633-5p in FA versus EA miRNA samples (n=70) after normalized to controls. In contrast, miR-323b-3p showed no difference between FA and EA after normalized to controls. For our future work, we plan to analyze multiple up- and down-regulated miRNAs by qPCR, determine whether the miRNA signatures are consistent between samples from FA versus EA, and explore the use of these miRNA signature differentials for affordable and rapid thyroid cancer screening and prognosis.

Minimally invasive video-assisted thyroidectomy (MIVAT) has gained acceptance as an alternative to conventional thyroidectomy. This technique results in less bleeding, postoperative pain, shorter recovery time, and better cosmetic results without increasing morbidity. We retrospectively assessed outcomes in 583 patients having MIVAT from May 2005 to September 2014. The study population was divided into groups according to periods: 2005 to 2009 and 2010 to 2014. Operative data, complications, and length of stay were collected and compared. Total thyroidectomy was undertaken in 185, completion thyroidectomy in 49, and hemithyroidectomy in 349. Malignancy was present in 127 (21.8%). Mean incision was 3.4 ± 0.7 cm and estimated blood loss was 23.7 ± 21.7 mL. Mean operative time was 86.5 ± 39.3 minutes for all operations, 78.5 ± 37.0 minutes for hemithyroidectomy, 70.9 ± 30.1 minutes for completion thyroidectomy, and 106.8 ± 41.3 minutes for total thyroidectomy. Postoperatively, 56 (9.6%) had unilateral vocal cord dysfunction, which resolved except for one case (0.17%). Fifty-nine patients (10.1%) developed hypocalcemia, but only three cases (0.51%) became permanent. Only one patient required readmission. In conclusion, MIVAT results in short operative times, minimal blood loss, and few complications and is safely performed in an academic institution.

After thyroid surgery, protocols based on postoperative parathyroid hormone (PTH) levels may prevent symptoms of hypocalcemia, while avoiding unnecessary prophylactic calcium and/or vitamin D supplementation. We examined the value of an initial management protocol based solely on a single PTH level measured one hour after completion or total thyroidectomy to prevent symptomatic hypocalcemia by conducting a retrospective review of 697 consecutive patients treated from July 2003 to April 2015. The proportion of patients who developed symptomatic hypocalcemia was similar between those treated before (n = 155) and after (n = 542) implementation of this 1-hour PTH protocol (16.8% vs 15.9%; P = 0.786). Those in the 1-hour PTH groups had lower overnight observation rates (97.4% vs 53.7%; P < 0.001) and length of stay (1.98 ± 2.61 vs 0.89 ± 1.87 days; P < 0.001), and required less calcium (3.9% vs 0.8%; P = 0.015) and vitamin D (2.6% vs 0%; P = 0.002) supplementation one year after surgery. Less than 1 per cent of patients discharged on the day of surgery in accordance with the 1-hour PTH guidelines returned to the emergency room for symptomatic hypocalcemia; none experienced significant morbidity. This protocol facilitates early discharge of low-risk patients and results in a similar or improved postoperative course compared with traditional overnight observation.

Filipino Americans (FA) are known to have a higher incidence, recurrence, and mortality of thyroid cancer (TC) than other Asians Americans or European Americans (EA). Understanding the molecular mechanisms that underpin the genetic defect in metabolism and their impact on thyroid cancer oncogenesis in FA are critical for addressing the health disparity. Mechanisms that link genetic defects and lifestyle factors to thyroid cancer progression have not been defined. Lifestyle and genetic variations among FA lead them to a higher risk of metabolic diseases but no study showed to elucidate the mechanism of thyroid health disparities cancer so far. Recent studies clearly demonstrate that miRNA plays an important role in carcinogenesis via targeting both oncogene and tumor suppressor gene and lifestyle changes may potentially alter miRNA signatures. Therefore, we hypothesize that miRNA expression contributes to tumor grade, prognosis, and thyroid cancer health disparities. We examined miRNA expression profiles in FA vs. EA. We analyzed miRNA-sequence (miRNA-seq) by next-generation sequencing (NGS). The pathways linked to miRNAs were analyzed by ingenuity pathway analysis (IPA) software. Correlations between disease staging to miRNA upregulation and downregulation were elucidated. Both upregulated and downregulated miRNAs were validated by quantitative real-time PCR (qPCR) using miRNA extracted from paraffin-embedded thyroid tissues. We found hundreds of upregulated and downregulated miRNA and piRNA from this study. We chose 10 miRNA down-regulated, and 10 up-regulated miRNA FA compared to EA TC patients (p Citation Format: Ryan Davis, Yan C Wongworawat, Mia C Perez, Krystal Santiago, Saurav Roy, Charles Wang, Alfred A Simental, Salma Khan. Upregulated and downregulated microRNA-signatures in thyroid cancer health disparities [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr B093.

Exosomes contain various molecular constituents of their cells of origin, including proteins and nucleic acid material. Exosomes have been isolated from blood, urine, saliva, synovial fluid, breast milk, cerebrospinal fluid, and various other body fluids and are also secreted by most cell types in culture. Although the exosomal protein content varies with the cell of origin, most exosomes contain an evolutionary-conserved common set of protein molecules detected by mass spectrometry. Heat shock proteins, CD63, and tetraspanins are the most prominent evolutionary-conserved proteins in exosomes. Cytoskeleton- and metabolism-related proteins form the pool of other frequently found proteins. Exosomes also contain proteins that are involved in cell signaling pathways, apoptotic pathways, and evasion of metastasis. The existence of these multifaceted proteins in tumor exosomes and its sources, isolation techniques and its association with cancer development, sustenance, and drug resistance is further expanded in different cancer types in this chapter.

Hyperparathyroidism is an uncommon disease, that is, usually diagnosed after a patient is found to have repeatedly elevated calcium levels on routine blood testing. Some patients may experience problems with recurrent kidney stones, memory difficulty, constipation, osteoporosis, or chronic fatigue. Patients exhibit chronic calcium and parathyroid hormone elevation, often undiagnosed for several years. Surgery is the definitive intervention, resulting in cure in 95% of patients when performed by an experienced parathyroid surgeon. Unfortunately, many patients initially receive surgical exploration by surgeons with limited experience, resulting in biochemical cure rates as low as 60%-70%. Unfortunately, recurrence may occur due to failed exploration, a second adenoma, or multigland hyperplasia. Resolution of the hyperparathyroid state requires additional surgery to remove any overactive parathyroid tissue. Reoperative surgery inherently brings increased surgical risks and decreased surgical success of cure. Hence, a focused and organized approach to this patient population is essential for optimizing the outcome of revision parathyroid surgery.

Papillary thyroid carcinoma (PTC) is the most common form of thyroid cancer and while it has a generally good prognosis, tumor recurrence remains a major clinical challenge. Studying laboratory cell lines as well as clinical specimens indicate that PTC may follow the cancer stem cell (CSC) model. However, CSC characteristics relevant in PTC initiation and progression remain largely unknown. Here we studied a population of sphere-growing tumor cells isolated from primary cultures of clinical PTC. These sphere-growing cells consisted of aldehyde dehydrogenase positive (ALDH+) and ALDH negative (ALDH-) cell subpopulations and demonstrated a hierarchical pattern of cell division. Using combinations of selective depletion, specific inhibition and cell sorting, we found that both subpopulations of the sphere cells were able to self-renew and initiate xenograft tumors independently, and fulfilled the definition of CSC. Importantly, when the subpopulations functioned together, the cancer-initiation efficiency and the xenograft tumor progression were significantly enhanced compared to either subpopulation alone. These data revealed crucial roles of ALDH- CSC in PTC biology and suggested that CSC subpopulations function cooperatively to control PTC initiation and progression. Together, our study indicates that CSC subpopulations isolated from clinical specimens offer unprecedented opportunities for investigating PTC pathogenesis and developing effective therapies.

The gradual deterioration following central nervous system (CNS) injuries or neurodegenerative disorders is usually accompanied by infiltration of degenerated and apoptotic neural tissue debris. A rapid and efficient clearance of these deteriorated cell products is of pivotal importance in creating a permissive environment for regeneration of those damaged neurons. Our recent report revealed that the phagocytic activity of olfactory ensheathing cells (OECs) can make a substantial contribution to neuronal growth in such a hostile environment. However, little is known about how to further increase the ability of OECs in phagocytosing deleterious products. Here, we used an in vitro model of primary cells to investigate the effects of lipopolysaccharide (LPS) and curcumin (CCM) co-stimulation on phagocytic activity of OECs and the possible underlying mechanisms. Our results showed that co-stimulation using LPS and CCM can significantly enhance the activation of OECs, displaying a remarkable up-regulation in chemokine (C-X-C motif) ligand 1, chemokine (C-X-C motif) ligand 2, tumor necrosis factor-α, and Toll-like receptor 4, increased OEC proliferative activity, and improved phagocytic capacity compared with normal and LPS- or CCM-treated OECs. More importantly, this potentiated phagocytosis activity greatly facilitated neuronal growth under hostile culture conditions. Moreover, the up-regulation of transglutaminase-2 and phosphatidylserine receptor in OECs activated by LPS and CCM co-stimulation are likely responsible for mechanisms underlying the observed cellular events, because cystamine (a specific inhibitor of transglutaminase-2) and neutrophil elastase (a cleavage enzyme of phosphatidylserine receptor) can effectively abrogate all the positive effects of OECs, including phagocytic capacity and promotive effects on neuronal growth. This study provides an alternative strategy for the repair of traumatic nerve injury and neurologic diseases with the application of OECs in combination with LPS and CCM.

Flexible fiberoptic nasopharyngolaryngoscope (FN) examinations are important to the practice of otolaryngology (ENT). We sought to assess whether a portable recording adaptor for the FN can enhance resident learning and improve patient management. The adaptor was used prospectively on consultations by first- and second-year ENT residents, and changes in diagnosis and management were recorded in the patient care workflow. In 43 patients, we found a 23% change in diagnosis, 44% change in management, and 19% change in surgical management after an attending reviewed recorded videos. Residents and attendings reported that discussing the video enhanced learning in 88% and 81% of cases, respectively. A portable FN recording adaptor has the potential to improve resident training and perhaps lead to more prompt health care delivery.

Thyroglossal duct and lingual thyroid ectopic lesions are exceedingly rare synchronous findings. Papillary thyroid carcinoma of these ectopic thyroid sites is well understood but still a rare finding. This case points to some management nuances in regard to ectopic thyroid screening with imaging and also shows the effectiveness of minimally invasive transoral robotic surgery for lingual thyroid.

Cancers of the hard palate and maxillary alveolus are uncommon and are most often squamous cell carcinoma. Etiologic factors such as tobacco and ethanol use are similar to those of other oral cavity cancers. Each of the oral cavity subsites has treatments and techniques uniquely designed for eradication of disease. In addition, each subsite has different functional and reconstructive options for the surgeon to individualize to each patient. While radiation therapy may be effective, cancers of the hard palate and alveolar ridge are safely and effectively treated with surgical resection. With an understanding of regional anatomy, surgery in this region can be performed reliably with very few complications and excellent functional recovery. Technological advances such as imaging and powered instrumentation have aided the technique of maxillary and hard palate cancer surgery.

With the advent of routine serum biochemical analyzers and the availability of inexpensive chemistry panels, the prevalence of primary hyperparathyroidism (HPT) has been estimated to be as high as 1% to 2%, with the majority of cases being asymptomatic. Primary HPT can occur as isolated sporadic disease or associated with heritable genetic disorders. The latter include familial hypocalciuric hyperparathyroidism (FHH), familial isolated HPT, HPT-jaw tumor syndrome (HPT-JT), and the multiple endocrine neoplasia syndromes, MEN 1 and MEN 2A. Aspects of sporadic HPT are indicative of molecular alterations in the tumor cells, such as those induced by exposure to ionizing radiation, a known risk factor for this disease. As described elsewhere in this issue, the most common form of primary HPT is related to the development of a single benign adenoma in an isolated gland, occurring approximately five times more frequently than hyperplastic multiglandular disease. Multiple adenomas and parathyroid carcinomas are clearly much less frequent, and differences in clinical features suggest that multiple molecular abnormalities are responsible for these phenotypes. This article focuses on sporadic and familial primary parathyroid disease, both benign and malignant. As molecular biology and genetic mapping receive wider application to human disease, genetic alterations have been identified with increased frequency in some patients with primary HPT. These alterations have been found in molecules related to cellular signaling and growth (RET protooncogene) and in tumor suppressors that control cell cycle progression and

Thyroid surgery over the past century and a half has evolved from an operation associated with considerable mortality and morbidity to a generally safe operation with relatively few complications. However, the risk of vocal cord paralysis and hypocalcemia remains and can be quite devastating to patients experiencing these problems. An adequate knowledge of the anatomy and surgical techniques regarding thyroidectomy is paramount to successful outcomes in this patient population. In this article we review the pertinent anatomy and surgical techniques and discuss their application.

Papillary thyroid carcinoma is the most frequent type of thyroid cancer. Although most PTC patients can be treated successfully and have an excellent prognosis, 10-20% of patients with stage I/II disease experience recurrence, developing invasive tumors and/or distant metastases. For these patients, a greater understanding of the mechanisms that govern PTC tumor initiation and progression would aid in developing effective therapeutic strategies to target the disease. It is becoming evident that thyroid tumors may follow the cancer stem cell model (CSC), where a population of cancer stem cells is responsible for tumor initiation and progression. Currently, the CSC biology of PTC is still poorly understood. In this study, we isolated sphere-growing cells from PTC specimen-derived primary cells using serum-free culture. In vivo transplantation analysis revealed that the sphere cells were capable of generating xenograft tumors that recapitulated the original tumor phenotypes. Analyzing the sphere cells for aldehyde dehydrogenase (ALDH) expression, a marker commonly used in CSC study, revealed that around half of the sphere cells did not express ALDH. When the sphere cells were sorted into ALDH- and ALDH+ subpopulations, both subpopulations demonstrated capabilities of re-initiating subspheres in vitro and generating serial xenograft tumors in vivo with the ALDH+ cells exhibiting a slightly higher efficiency of sphere-formation and cancer-initiation. Of major importance, the sphere cell population without sorting demonstrated the higher levels of cancer-initiating cell frequency, and quicker xenograft tumor progression than the subpopulations of ALDH- and ALDH+ cells. Furthermore, histologic investigation of xenograft tumors generated by the sphere population and the sphere-sorted subpopulations, respectively, revealed similar morphological features that recapitulated the characteristics of original human PTC from which the sphere cells were isolated. Our data established a vital role of ALDH- cancer stem-like cells and revealed a potential synergistic activity between ALDH- and ALDH+ cells in the tumor initiation and progression of PTC. Further exploring the biological property of ALDH- cancer stem-like cells may lead to development of novel therapeutic solutions to treating aggressive PTC. Citation Format: Alfred Simental, Steve Lee, Pedro A. De Andrade Filho, Nathaniel R. Peterson, Saied Mirshahidi, Penelope Duerksen-Hughes, Xiangpeng Yuan. Characterization of papillary thyroid carcinoma primary cell culture derived cancer stem-like cells [abstract]. In: Proceedings of the AACR-AHNS Head and Neck Cancer Conference: Optimizing Survival and Quality of Life through Basic, Clinical, and Translational Research; April 23-25, 2017; San Diego, CA. Philadelphia (PA): AACR; Clin Cancer Res 2017;23(23_Suppl):Abstract nr 60.

Program Description:Key aspects of thyroid surgery have been addressed by published clinical practice guidelines, consensus statements, and position papers from the American Academy of Otolaryngology—Head and Neck Surgery Foundation (AAO-HSNF), the American Head and Neck Society (AHNS), and the American Thyroid Association (ATA). This miniseminar efficiently presents these society publications, focusing on their content, interpretation, and limitations. Specific topics include surgery for invasive carcinoma, imaging selection, improving postoperative voice outcomes, nerve monitoring, outpatient surgery, and goiter management. These documents will also be used to highlight the important overall differences between practice guidelines, consensus statements, and position papers and their respective influence on clinical decisions.Educational Objectives:(1) Differentiate between a clinical practice guideline, clinical consensus statement, and position paper. (2) Analyze the content, interpretation, and limita...

Summary Objectives PARP inhibitors (PARPi) may provide an opportunity to gain selective killing of tumor cells which have deficiencies in cellular DNA repair systems. We previously demonstrated linifanib (ABT-869), a multi-receptor tyrosine kinase inhibitor of VEGF and PDGF receptor families, radiosensitized Head and Neck Squamous Cell Carcinoma cells (HNSCC) via inhibiting STAT3 activation. Given that STAT3 can modulate DNA damage response (DDR) pathway, in this study, we evaluate the effects of linifanib to enhance cytotoxicity with the PARPi, veliparib (ABT-888), in HNSCC. Materials and methods UMSCC-22A and UMSCC-22B cells were treated with linifanib (ABT-869) and veliparib (ABT-888). Cell viability, cytotoxicity, apoptosis induction, DNA single strand break (SSB) and double strand break (DSB) damages were examined by MTT assay, colony formation assay, flow cytometry and comet assay. In addition, the expression of DNA homologous recombination repair protein Rad51, γH2AX, a double strand break marker and cleaved PARP, an apoptotic cell death marker, were assessed using western immunoblotting. Results Combination treatment resulted in more cell growth inhibition, induction of apoptosis, DNA damages and double strand breaks, lower expression of Rad51, increase γH2AX expression and PARP cleavage. Conclusion These data suggest the possibility of combining targeted therapeutic such as linifanib with veliparib to augment the inhibition of cell growth and apoptosis via synthetic lethality in HNSCC cells. Thus, it may provide a novel therapeutic strategy and improve efficacy and outcome in HNSCC.

Ranulas present as a painless cyst on the floor of the mouth. They present in varying sizes, ranging from the small ranula on the floor of the mouth to large plunging ranulas that extend through to the neck. Treatment options vary depending on the size of the ranula and the operative techniques. This article describes the authors' methods for treating ranulas.

Objectives: Squamous cell carcinoma has a predilection for regional lymphatic metastasis. The occurrence of occult cervical metastases from squamous cell carcinoma of the hard palate and maxillary alveolar ridge has not been studied systematically. We have observed many patients who have returned after resection of a primary cancer in these sites with a delayed cervical metastasis. Some of these patients have died of regional or distant metastasis despite control of their primary cancer. Methods: We have studied 26 patients with squamous cell carcinoma of the maxillary alveolar ridge and hard palate to define incidence of cervical metastasis. Results: Overall incidence of cervical metastasis was: clinical 2 of 26 (7.6%) and occult 7 of 26 (27%) for a total of 9 of 26 (34.6%). The 5-year disease-specific survival was 13 of 22 (59%). Surgery for regional failure was successful in 66% (6 of 9). Radiation was administered after surgery in eight of nine patients. Conclusion: Cervical metastasis from cancer of the palate and alveolar ridge is significant. Regional surgery for recurrent disease usually requires radical or modified radical neck dissection. Selective elective neck dissection should be offered to patients with cancer of the hard palate and alveolar ridge. It affords the patient and the treatment team valuable histologic information, which may help to guide therapy and reduce the potential need for future hospitalization, chemoradiation, and more radical surgery.

Program Description:Otolaryngologists perform a variety of surgeries, many of which inherently have a small margin for error. While most surgeries are uneventful, complications present special challenges and may create anxiety among surgeons. This miniseminar will employ a multidisciplinary approach to create a paradigm for management of the unwanted surgical complication. A case-based approach will be used to highlight common complications. Methods for prevention will be reviewed and keys for management of the unwanted complication will be presented. Cases from each otolaryngology subspecialty will be presented with opportunity for audience interaction and questions.Educational Objectives:1) Recognize common complications within otolaryngology-head and neck surgery. 2) Evaluate measures that can be taken preoperatively and intraoperatively to prevent complications. 3) Describe methods to manage common complications.

Objective: Several thyroidectomy techniques are available today, both traditional and advanced. However, little data is available regarding patients’ preference and understanding of their options. The purpose of this study is to 1) evaluate patents’ choice prior to thyroid surgery; and 2) examine factors that influence it.Method: This study was conducted at the tertiary medical center between October 2010 and February 2011. Patients visiting the surgery clinic for evaluation of thyroid pathology were given a 2-part questionnaire regarding their knowledge of different thyroidectomy techniques and factors which influence their choice.Results: The majority of patients had no prior knowledge of thyroidectomy techniques (82.3%) and did not conduct research on their own prior to surgical consultation (70.6%). Patients who reported research spent less then 6 hours, used various sources, and traveled less then 30 miles to the clinic. No patients claimed knowledge of different advanced thyroidectomy techniques. Mo...

Objective: Often, extensive workup (H&P, CT/MRI/FDG-PET, tonsillectomy and biopsies) is undertaken to detect the primary tumor of a cervical metastasis, in order to reduce morbidity of treatment. We report on transoral resection of the base of tongue (at the time of panendoscopy) in the diagnostic management of unknown primary HN cancers.Method: In this retrospective study, we reviewed findings from workups of Loma Linda University patients with unknown primary HN cancer in the past 4 years (when base of tongue resection was instituted) and noted the number of primary unknowns detected by base of tongue resection vs traditional diagnostic modalities.Results: In the past 4 years, 17 patients underwent panendoscopy for the diagnosis of an unknown primary cancer after careful outpatient workup, including CT/PET studies, failed to reveal a source. Of this group, a primary source was found in eight by tonsillectomy and directed biopsies. In the remaining 9, transoral laser resection of the ipsilateral base of ...

The minimally invasive video-assisted thyroidectomy technique has slowly gained acceptance. Previous studies have reported advantages of better cosmetic results and faster postoperative recovery. We report preliminary results from our single assistant technique over the initial two years of inception at an academic training center.This study consists of a retrospective chart review of 172 cases between May 2005 and September 2007. All cases started as video-assisted thyroidectomy were included. Demographic, pre- and postoperative clinical data, imaging results, and hospital stay were collected.Acceptable data were available for 24 male and 148 female patients who underwent the video-assisted procedure. Five cases were converted to the conventional thyroidectomy. Of the 172 cases, 60 total thyroidectomies and 112 hemithyroidectomies were performed, with 37 cases of malignancy. The average hospitalization was 1.43 days with mean incision length was 3.51 cm, mean surgical time of 91.37 minutes, and mean blood loss of 31 cc. Transient voice problems were noted in 10 patients.We found statistically improved operative times, hospital stay, and blood loss the first 2 years with a low rate of temporary complications. It appears that minimally invasive video-assisted thyroidectomy is a safe and feasible option to standard thyroidectomy in selected patients.